Living With Your Fertility ThroughNatural Family Planning
Fourth Edition © - 2009 Generic Short
Authors: Richard J. Fehring, PhD, RN
Professor and Director
Marquette University
Institute for Natural Family Planning Kathleen Raviele, MD, Ob/Gyn
Private Practice Atlanta
NFP Promoter, NFP teacher, and
NFP medical consultant
What do you think of when you hear the term Natural Family Planning?
What do you hope for in your marriage?
Objectives of Presentation Define Natural Family Planning (NFP)
Describe how NFP works
Discuss effectiveness of NFP methods
Explain marital and spiritual benefits of using NFP
Definition of NFP
Methods of monitoring and interpreting natural biological markers of fertility
To help determine the fertile and infertile times of a woman’s menstrual cycle
Information can be be used to achieve or avoid pregnancy
NFP Also Means: Abstaining from intercourse and genital
activity during fertile time of cycle if avoiding pregnancy
Developing non-genital ways of expressing intimacy during the fertile times
Not using any artificial means to interfere with fertility
Openness to life
METHODS OF NFP
CALENDAR/RHYTHM BASAL BODY TEMPERATURE OVULATION METHOD SYMPTO-THERMAL HORMONAL MONITORING
So – How Does NFP Work?
Six Day Fertile Window
A man and woman together are fertile for only 6 days.
The day of ovulation when a egg is released.
And the 5 days before ovulation!
Phases of the Menstrual Cycle
Pre-Ovulatory
Infertile Phase
Fertile Phase
Post-Ovulatory
Infertile PhaseOvulation
Variability of the Cycle1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Female Anatomy: Front View
Vagina
Cervix
Uterus
Ovary
Fallopian Tube
Vulva
Female Cervix: Produces thin watery
fertile mucus when stimulated by estrogen
Sperm live in good mucus 3-5 days
Produces thick mucus plug when stimulated by progesterone
Female Ovary
Developing Follicle
Ovum Released at Ovulation
Corpus Luteum
Ovum (Egg) In Ripe Follicle
NFP measures:Estrogen - secreted by follicle Stimulates cervical mucus production
LH - secreted by pituitary Stimulates ovulation
Progesterone - secreted by corpus luteum Raises basal body temperature Dries cervical mucus
Female Menstrual Cycle
LH
FSH
Estrogen
Progesterone
Hormone Levels 28 Day Cycle
Day 5 10 14 22 25
NATURAL BIOLOGICAL SIGNS OF FERTILITY
Calendar Formulas Changes in Resting Body Temp Changes in Cervical Mucus Changes in Female Hormones
Markers for the Beginning of Fertile Phase
Presence of cervical mucus Rising levels of the hormone estrogen Shortest cycle minus 20 days; or day “8”
Markers of Peak Fertility
Cervical mucus – clear, stretchy, slippery Rise in basal body temperature LH hormone peaks
Markers for the End of the Fertile Phase
Peak in cervical mucus plus count of 3 Rise in temperature plus count of 3 Peak in LH plus count of 3 Longest cycle minus 10 days; or day “19”
Mucus Cycle
Peak
Fertility
Beginning End
The BBT Chart1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
98
97
Biphasic Shift
Temps are low pre-ovulatory
Clearblue Fertility Monitor
Low Fertility
High Fertility
Peak Fertility
Basic Instructions for Achieving and Avoiding Pregnancy
Achieve - Have intercourse during the fertile window!
Avoid – Don’t have intercourse during the fertile window!
NFP Efficacy Studies
Terms The perfect or correct use unintended pregnancy rate refers
to those pregnancies that occur when the method is used consistently and according to instructions.
The typical use (or total) pregnancy rate includes the combination of unintended pregnancies when the methods are followed correctly and the unintended pregnancies that occur when users of the method do not always follow the instructions of the method correctly.
Classic and Recent NFP Efficacy Studies: Correct Use and Typical Efficacy Rates* per 100
Women Over 12 Months of Use ______________________________________________________________________________
Study/Year Indicators Length** Correct Total______________________________________________________________________________
WHO (1981) Mucus (25-32) 97 78 Indian Medical (1996) Mucus (21-36) 99 90Howard, et al.(1999) Mucus (25-32) 100 86 Arevalo, et al.(2002) Fixed Calendar (26-32) 95 88 Arevalo, et al. (2004) Mucus (13-42) 96 86Frank-Hermann, et.al.(2007) Mucus & Temp (25-35) 99 92Fehring, et al.(2007) Mucus/EHFM*** (21-42) 98 87______________________________________________________________________________* Rate = percentage of women per 100 that did not have an unintended pregnancy.** Range of length of menstrual cycles in study.*** EHFM = electric hormonal fertility monitoring
Effectiveness of NFP*
Perfect Use - 97%
Typical Use - 84%
Perfect Use - 98%
Typical Use - 90%
Single Index Methods
Multiple Indexed Methods
•Kambic, R - The Effectiveness of Natural Family Planning, Current Medical Research; Vol 11; Winter/Spring, 2000. Based on meta-analysis of 23 ovulation methods studies and 15 STM studies. •*Effectiveness rates are calculated on 100 women over 12 months of use.
Pregnancy rate over one year by family planning method
Correct Use Typical Use• CHANCE 85 85• SPERMICIDES 18 29• WITHDRAWAL 4 27• CONDOMS 2 15• SDM 5 12 • OVULATION METHOD 3 16• SYMPTOTHERMAL 2 11• PILL 0.3 8• IUD 0.1 0.6
* Table adapted from:Trussell J. Contraceptive failure in the United States. Contraception. 2004;70:89-96.
Effectiveness of NFP
With accurate charting Accurate observations Consistent use Mutual motivation and loving cooperation NFP is close to 98% effective!
Classic Methods of NFP
Billings Ovulation Method
Cervical Mucus Correct Use = 99.0 - 100% Typical Use = 89.5 - 97.5%
Representative Studies of the BOMS Thapa, MV Wonga, PG Lampe, H Pitojo, A Soejoenoes. Efficacy of three variations of periodic abstinence for family
planning in Indonesia. Studies in Family Planning, 21: 327-34, 1990.JX Xu, JH Yan, DZ Fan, DW Zhang. Billings natural family planning in Shanghai, China.
Advances in Contraception, 10: 195-204, 1994.Indian Council of Medical Research Task Force on NFP. Field Trial of the Billings Ovulation Method of a Natural Family
Planning. Contraception 53: 69-74, 1996.
Creighton Model System (CrM) Standardized form of
the Ovulation Method Basis for what is called
NaProTechnology Correct Use = 99.9 Typical Use = 96.8
Hilgers TW and Stanford JB: Creighton Model NaProEducation Technology for Avoiding Pregnancy: Use Effectiveness. J. Repro. Med. 43: 495-502, June, 1998.
Sympto-Thermal Methods: STM• Combines indicators of
fertility• Common indicators are BBT,
cervical mucus, and calendar formulas
• Provided by Couple to Couple League and Northwest Family Systems
• Correct Use = 99%• Typical Use = 85 – 94%
Rice, FJ & Lanctot, C.A., Results of a Recent Study of the Sympto-Thermal Method of Natural Family Planning, Linacre Quarterly 45:4 (November, 1978), 388-391.
New Methods of NFP
Standard Days Method (SDM) Days 8 – 19 fertile
Cycle length 26 – 32
Correct Use = 95%
Typical Use = 88%
Arevalo M, Jenning V, Sinai I. Efficacy of a new method of family planning the Standard Days Method. Contraception 2002;65:333-338.
Efficacy of the TwoDay Method Did I note any
secretions today?
Did I note any secretions yesterday?
Correct use = 96.5% Typical =
86.3%Arevalo, Jennings, et al., Efficacy of a new method of family planning. Fertil Steril, 2004: October Issue.
European Double Check Use of two indicators
of fertility Temperature &
Cervical Secretions
Correct Use = 99.4% Typical Use = 98.2%
Frank-Herrmann, P. et al., (2007). The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple's sexual behaviour during the fertile time: a prospective longitudinal study. Human Reprod. 22(5):1310-9.
Sympto-Hormonal Method CPEFM plus Cervical mucus
Correct use = 98-99% Typical use = 87-90%
Fehring, Schneider, Raviele , 2007. JOGNN 36(2):152-160.
Fehring, Schneider, Barron, 2008. MCN 33(6):348-354.
Spiritual-Psychological Dynamics of Natural Family Planning
Challenges of Living With Your Fertility
Benefits of using NFP Understanding fertility Safe and healthy Communication Increased intimacy Increased self-mastery Sharing and generosity to life Fits with moral, ethical and spiritual beliefs
Fertility is a holy time -- NFP couples
realize AWESOMENESS of the fertile time
Possibility to be co-creators with GOD
Possibility to create new IMAGES OF GOD
Deepening Conjugal Love
Couples who regulate their fertility by living NFP grow in personal dignity and enjoy a deepening of their conjugal love.
Natural Family Planning
“NFP strengthens conjugal love and helps to establish families in peace and security.”
Drs. John and Evelyn Billings
Grow in God’s Love!
Web Sites of NFP Programs Billings Ovulation Method Association – USA (BOMA) http://www.boma-usa.org/ Couple to Couple League International (CCL) http://www.ccli.org/teach/index.shtmlh Family of the Americas Foundation (FAF) http://www.familyplanning.net/index-aboutus.html Marquette University College of Nursing http://www.mu.edu/nursing/nfp/training.html Northwest Family Services http://www.nwfs.org/index.t?goto=nfp The Pope Paul VI Reproductive Institute http://www.mitec.net/~popepaul/Education1.htm
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